Blisters may need medication for life, fungus needs culturing

DEAR DR. ROACH: A year ago, I broke out with pimples on my back, arms and thighs. They itched so badly I thought I would go mad. A dermatologist took a biopsy and told me it was an autoimmune disease called bullous pemphigoid. I was started on prednisone and doxycycline. When it cleared up, I would stop the medication, but it came back. The doctor said she thinks I’ll have to take medication for the rest of my life. I don’t like taking this medication, as it blurs my eyesight and I lose energy. I also have osteoporosis. I do take some vitamins. – G.B.

ANSWER: Bullous pemphigoid is an autoimmune disease that causes blisters, mostly in older adults. The blisters are large and tense (as opposed to pemphigus, an even more dangerous autoimmune disease, in which the blisters are soft). Bullous pemphigoid tends to come and go over months or even years. Diagnosis is confirmed by biopsy.

The usual treatment for bullous pemphigoid is a corticosteroid, either topical or systemic. Since it was over such an extended area of your body, your dermatologist decided on systemic treatment at a moderate dose of 20 mg. Prednisone has many long-term side effects, including making your osteoporosis much worse. Further, I am concerned that the blurry vision could indicate the onset of diabetes or a cataract, as both are strongly associated with chronic steroid use. Your regular doctor should be testing you for diabetes and treating the osteoporosis, and should make sure that you see the eye doctor.

Certain medications, such as the doxycycline she started you on, can reduce your need for steroids. Other medications used for autoimmune disease can further reduce the need for steroids, but azathioprine, methotrexate, mycophenolate and others have serious side effects of their own. Nicotinamide, also called vitamin B-3, can make the doxycycline more effective.

Although bullous pemphigoid sometimes does go away, I agree with your doctor that you are likely to need some medication long term; however, she may be able to reduce the dosages.

DEAR DR. ROACH: My adult daughter contracted ringworm or some other fungus from her beautiful Border Collie. She has been using over-the-counter meds on the two of them for over 10 months! The dog is doing better than my daughter. Any solutions to get rid of this once and for all? – E.B.

ANSWER: Ten months is too long to treat something empirically. It’s time to find out what this fungus might be, and that means a visit to a dermatologist, who can do a culture of the infection to find out what it is. There are some unusual fungi that can be passed from animals (dogs, cats, pigs, horses, cattle) to humans and cause skin infection. Rarely is systemic treatment necessary.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu. To view and order health pamphlets, visit www.rbmamall.com, or write to Good Health, 628 Virginia Drive, Orlando, FL 32803.